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General NPI Number Information
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NPI Number | 1417141888
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Entity Type | Individual
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Provider Name | BRIDGET I MARK
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Gender | Female
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 1200 BRAUN RD
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City | BETHEL PARK
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State | PA
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Zip | 15102-3106
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Country | US
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Telephone | 412-854-5500
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Fax | 412-854-4742
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Provider Business Mailing Address
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Address Line | 106 CANCILLA DR
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City | CANONSBURG
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State | PA
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Zip | 15317-1828
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 1768
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SL003065L
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License Number State | PA
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